Yale University researchers have developed an app for tablet devices that has the potential to reduce unnecessary CT exams.

In 2013, more than four out of five head CT scans performed in emergency departments didn't meet recommendations for appropriate use, according to an Advisory Board article.

The new app categorizes head injuries as low-, medium-, or high-risk, based on a short list of criteria. Depending on the degree of risk, the app shows how many patients out of 100 would benefit from a scan, based on research.
Then a "risk discussion" screen appears that poses questions such as, "What are you most concerned about?" This helps to facilitate a conversation between the physician and patient with the goal of coming to a shared, evidence-based decision about the exam.

CT overutilization doesn't just expose patients to unnecessary ionizing radiation, it also adds large and unnecessary expenses to care.

“The tool and technology is a starting point,” Dr. Ted Melnick, lead author of a study investigating the app published in the Journal of Medical Internet Research, said in a statement. “It offers some cues and ideas to guide the conversation, which is about sitting down with the patient and educating them in terms of different types of head injury.”

Melnick and his team started by creating a prototype of the app to test on patients, emergency department clinicians, researchers and designers. After several rounds of testing and retooling, they settled on a version of the app they named Concussion or Brain Bleed.

A Yale-led study published in Academic Emergency Medicine in November 2015 found that strengthening the relationship between the physician and patient is key to reducing CT overuse.

The research showed that many nonclinical factors influenced medical decisions that led to unnecessary scans. For physicians, that included a lack of confidence, influence from others, and time. For patients it was the physician's ability to listen and care for them.

“When a doctor takes time to listen and care for a patient, and the patient sees the doctor cares, the patient is more willing to trust the doctor’s recommendation [as to] whether CT scan is indicated," said Melnick.

Unlike other decision-support tools, the Concussion or Brain Bleed app is designed to be used by both the physician and patient. This puts the patients at the center of the decision.

Melnick and his team are conducting additional pilot tests and plan to expand testing to a larger group of physicians and facilities. They are continuing to gather feedback and refine the app and eventually hope to conduct a large-scale implementation trial.

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